Addition of aerobic training to conventional rehabilitation after hip fracture: a randomized, controlled, pilot feasibility study

Abstract

Objectives: To determine the feasibility and safety of aerobic training with an arm crank ergometer and its effectiveness in improving functional capacity and gait in patients with recent hip fracture. Design: Randomized, controlled, assessor-blinded pilot study, with intention-to-treat analysis. Setting: Inpatients, rehabilitation department. Subjects: 40 patients with hip fracture surgically treated. Interventions: Training group performed aerobic exercise with an arm crank ergometer (15 sessions, 30 minutes/day) at an intensity of 64% to 76% of maximum heart rate, in addition to conventional inpatient rehabilitation. Main measures: Primary outcome was the feasibility (including eligibility rate, recruitment rate, number of drop-outs and adverse events, adherence). Secondary measures were the Timed Up and Go test, ability to walk independently, muscle torque of knee extensors of fractured and non-fractured leg, Functional Independence Measure. Results: Mostly due to pre-existing disability and fracture type, only 40/301 (13%) patients were eligible (age 84.6 ± 7.6 years, 75% female); all agreed to participate and 90% completed the trial, without adverse events. Adherence to aerobic exercise was good, with high attendance at sessions (93%), a strong compliance to exercise duration (95%) but lower compliance to the prescribed intensity (73%). After the program, more patients were able to walk independently in the training group ( n = 18) compared to control ( n = 13) ( P < 0.05). Also the muscle torque of fractured leg knee extensors was higher in the training group ( P < 0.05). Conclusion: Aerobic training in addition to conventional rehabilitation after a hip fracture is feasible and safe and it was effective in improving gait performance and strength of fractured leg. Trial registration: NCT04025866.

Effects of Aerobic Training in Patients with Subacute COVID-19: A Randomized Controlled Feasibility Trial

“…However, more repetitions of the 30 s STS in both groups at follow-up were still below the normative value for 70 years old elderly [ 65 ]. These results are in line with our previous study [ 33 ]. Notably, in patients with recent femur fractures, aerobic training with an arm crank ergometer did not result in a greater improvement in performance compared with those who underwent only standard rehabilitation and did not reach the normal range in the brief rehabilitative period.…”

“…The addition of aerobic exercise performed with an arm crank ergometer appears to be beneficial for people with subacute COVID-19. Previous studies have reported that arm aerobic exercise can be an effective training modality among healthy older people and patients with hip fractures, peripheral arterial disease, and post-stroke [ 33 , 59 , 60 , 61 ]. The benefits gained regard not only the cardiovascular function but also the physical functional performance, such as walking, balance, mobility, and motor acquisition since several lines of evidence suggested that a single bout of moderate-intensity aerobic exercise may also be enough [ 62 ].…”

“…This assessment was performed with the use of a handheld dynamometer (Lafayette Manual Muscle Tester, model 01163, Lafayette Instruments, Lafayette, IN, USA). The patients were required to perform a sub-maximal contraction in knee extension, followed by two maximal contractions during which the physiotherapist gave verbal encouragement [ 33 ]. Standardized instructions were used: “When I instruct you to start, push against the dynamometer as hard as you can until I tell you to stop”.…”

“…The mean value of the two right-leg and left-leg tests was recorded. The measurements were converted from kg to (N·m)/kg using the formula: [(peak force (kg) × 9.81) × distance from joint (m)]/weight (kg) [ 33 ].…”

Pre- and Postoperative Exercise Effectiveness in Mobility, Hemostatic Balance, and Prognostic Biomarkers in Hip Fracture Patients: A Study Protocol for a Randomized Controlled Trial

“…These consequences last months after surgery, with 50% experiencing reduced functionality within one year, while only 30% regain full functionality [15]. Exercise has significant benefits for several of these variables, such as the level of independence and self-care [16,17], the faster clearance of accumulated lactate [18,19], the increased activity of pyruvate dehydrogenase [20] and the immediate enhancement of cognitive functions [21]. Hemostasis is also linked to exercise physiology, as it affects blood coagulation, fibrinolysis and platelets [22].…”